High Risk OB Flashcards
What is Dilation?
Extent of cervical dilation from 1-10cm
What is Effacement?
Percent of thickness of the cervix. Normally 2 cm thick and thins during labor. When thinned to 1 cm patient is 50% effaced.
What is Lie?
Longitudinal orientation of fetus in relation to longitudinal orientation of mother.
What is Station?
Fetal head in relation to mother’s pubic bone and is expressed as - or + number in cm.
What is Presentation?
What is attempting to emerge first? Cephalic, Breech, or Shoulder.
What are baseline Fetal Heart Tones?
120-160 /min
What is the single most important predictor of fetal well being?
1 cause of poor variability is fetal hypoxia
Variability (should be between 10-15 bpm)
What causes poor variability?
Fetal hypoxia
Smoking
Sedatives/analgesics administered to mom Extreme prematurity
Fetal sleep.
What are Accelerations?
Usually associated with fetal movement and CNS response to stimuli.
Usually good, Hypoxic fetus with metabolic acidosis cannot accelerate the heart.
Early Decelerations
Typical vasal response to squeezing of the head caused by strong contractions.
Usually ok if occurring at same time as contractions.
Late Decelerations
Indicate uteroplacental insufficiency causing fetus to experience a hypoxic bradycardia.
BAD
What are Late Decelerations commonly associated with?
Pregnancy induced hypertension
Diabetes
Smoking
Late deliveries
Variable Decelerations
Cord compression commonly occurring during contractions.
Look for cord problems (prolapse, short, entanglement, nuchal).
Typically V or W shaped waveforms on monitor.
What is Shouldering?
Deceleration followed by a short Acceleration to compensate.
Good thing!
Sinusoidal variation
Typical of Fetal hypovolemia or anemia.
Caused by accidental tap of umbilical cord during amniocentesis, fetomaternal transfusion, or placental abruption.
Very Bad
Fetal Heart Rate Bradycardia
<120 for 5-10 minutes
Most common cause is hypoxia
Fetal Heart Rate Tachycardia
> 160 for >10 minutes
Most common cause is maternal fever (sepsis)
Factors contributing to fetal distress (6)
Hypertonic or tetanic contractions (Discontinue oxytocin)
Rule out cord prolapse
Assure fetal oxygenation (Give mom high flow O2)
Maternal hypotension (250-500 ml bolus)
Placental abruption (Trauma, bleeding)
Change positions (Left lateral recumbent)
S/S of imminent delivery
Vaginal bleeding Contractions less than Q10 Increasing intensity of contractions Urge to push Crowning
Preterm Labor Tocolytics
Terbutaline (0.25 mg SQ Q15) Magnesium Sulfate (4-6G bolus over 15 min, 2 G/hr drip)
S/S of Magnesium Toxicity and treatment
Decreased deep tendon reflexes
Decreased BP
Decreased LOC
Respiratory depression
Give calcium chloride, push fluids to cause diuresis
Ectopic Pregnancy
Every woman of child bearing age with acute abdominal complaints is an ectopic pregnancy until proven otherwise.
Cross match blood, Give Rhogam if mom is RH-
Who is most at risk for Pregnancy induced hypertension?
African American Females
Signs of pre-eclampsia
Hypertension
Proteinuria
Edema
HELLP syndrome
Hemolysis
Elevated Liver enzymes
Low Platelet count
Eclampsia Treatment
Give Diazepam PRN for seizure activity with MgSo4 (Magnesium Sulfate)
What causes Abdominal Aortic Aneurysm in pregnancy?
50% of women under 40 with AAA are pregnant. Gravid uterus increases pressure on distal aorta and femoral arteries.
Trauma in Pregnancy
Maximize fetal viability in trauma by aggressive treatment of mom.
Can lose 30-35% of blood volume before hypovolemia presents.
Seatbelt placement causes abruptio placenta.
What is Placenta Previa?
Placenta attached over cervical opening.
Often presents with painless bright red vaginal bleeding.
Common causes of Placenta Previa?
Uterine scarring
Multiparity with short intervals
Post D/C
Treatment of Placenta Previa
High flow O2, IV fluids
Consider tocolytics and blood products
Assess contractions, fetal movement, fetal heart tones, and hemorrhage.
What is Placenta Abruptio?
Tearing of uterine wall and placenta vasculature
S/S of Placenta Abruptio
“Ripping or tearing pain” with Dark blood or no evidence of blood loss.
Can cause exsanguination and Placental insufficiency.
Blood irritates uterus and will cause contractions.
Treatment of Placenta Abruptio
High flow O2, IV fluids
Consider tocolytics and blood products
Assess contractions, fetal movement, FHT
Watch for DIC.
Uterine rupture treatment
Serial fundal height measurements, rapid transfer, oxytocin 20-40 units in 1000ml @ 125hr.
What is a Nuchal cord?
Cord is wrapped around neck.
Causes Variable Decelerations.
Treatment of Nuchal cord
Focus on relieving cord tension before next contraction. Try to gently loosen and draw down over head, clamp and cut before shoulders are delivered if it is too tight to remove.
Treatment of cord prolapse
Elevate presenting part off the cord with a hand in the vagina to prevent cord compression.
Place patient in knee to chest position.
Consider tocolytics to reduce pressure on the cord during contractions.
Breech presentation
True breech=butt first
Footling breech = foot first (do not attempt to deliver)
Fetus should not be touched until the umbilicus has spontaneously delivered.
Treatment of Breech presentation
Mauriceau’s maneuver.
Insert fingers into vagina to create airway for baby, after shoulders have been delivered, rotate baby’s trunk so that the back is anterior and apply gentle downward traction while another provider applies suprapubic pressure.
When to suction meconium
Suction mouth, posterior pharynx and nose after delivery of head but before shoulders.
If baby is not vigorous, suction mouth and trachea with ETT.
Define vigorous neonate
Strong respiratory efforts,
Good muscle tone
Heart rate greater than 100.
Normal first APGAR is 8-9.
What does APGAR stand for?
Activity (active) Pulse (>100) Grimace (response to stimuli) Appearance (pink) Respirations (vigorous cry)
Post-partum hemorrhage treatment
Vigorous fundal massage
Rapid infusion of Oxytocin 20-40u /1000 ml
Methergine 0.2mg IM
Bimanual uterine compression
Uterine inversion treatment
Manual replacement is the uterus has not yet contracted down and cervix has not constricted. Do not remove placenta.
3 ways to confirm preterm rupture of amniotic membranes
Positive nitrazine testing of fluid
Pooling of fluid in vaginal vault
Positive ferning on microscopic slide
During pregnancy, maternal cardiac output increases by ___.
2 L/min
During pregnancy, maternal plasma volume increases by ___.
40%
Placenta has a very high concentration of ____.
Tissue thromboplastin
Why do pregnant females have difficulty breathing?
Functional residual capacity is decreased by 20%
Increased blood volume causes capillary engorgement causing airway swelling
Initial treatment of preterm rupture of amniotic membranes
IV fluids
Left lateral decubitus position
Contraindications of Terbutaline
Maternal pulse greater than 120 Insulin-dependent diabetes Chronic hypertension Active hemorrhage Chorioamnionitis (intra-amniotic infection)
What maneuver may be used to help deliver an infant with shoulder dystocia?
McRobert’s maneuver. Knees to chest with gentle downward traction.
Complications associated with breech presentation (6)
Cord prolapse Cord entanglement Cord compression Head entrapment Fetal birth trauma Birth asphyxia
Emergency C-Section indications
Multiple decelerations with poor rate / variability Sustained Bradycardia (<120 BPM for >10 minutes) Sinusoidal waveform
What is the most common cause of preterm labor?
Hypovolemia
Anaphylactoid syndrome of pregnancy
Caused by maternal exposure to fetal cells.
DIC and Anaphylaxis at the same time
Treatment of Anaphylactoid syndrome
Fluid resuscitation
Increase PEEP
FFP, Platelets, Cryo
1 cause of maternal death
Trauma
1 cause of fetal death
Maternal death
“Stomach as hard as a board”
“Fetal parts presenting under the mother’s skin”
Uterine rupture!
True or false: If a mother is Rh negative, Always give Rhogam
True
When to give Rhogam
28 weeks gestation
After delivery
After any trauma / bleeding / potential bleeding
Common cause of newborn seizures
Hypoglycemia
Gestational diabetic mothers are more likely to give birth to children with ____.
Hypoglycemia
